Fraude y abuso

Fraud and Abuse Medicaid

Fraud, abuse and waste are widespread in the health care industry and generally result in the increase of health care costs. The health plan is dedicated to fight fraud, abuse and waste through its Fraud Prevention Program. This program is designed to detect and eliminate health care fraud, abuse and waste.

The most common types of health care fraud, abuse and waste are:

Billing for services never provided

Billing for more expensive services then were actually provided

Incorrectly stating a diagnosis to get higher payments

Performing unnecessary services to get higher payments

Misrepresenting non-covered procedures as medically necessary

Selling or sharing a member's identification number for the purpose of filing false claims

If you believe you have information relating to health care fraud, abuse and waste, please contact our Fraud Prevention Department. The Department will review the information provided and will maintain the highest level of confidentiality as permitted by law. Suspected acts of fraud, abuse and waste may be submitted by using our Fraud and Abuse Form found below on this web page.

You may prefer to contact our Special Investigations Unit by calling 1-866-806-7020 or our Aetna Medicaid Compliance Hotline number at 1-855-421-2082.

You do not have to leave your name or any information about yourself to report these types of issues. We will make every effort to protect your identity. We cannot take any action against you for letting us know about any fraud or abuse activities with the health plan.

You can also contact the Michigan Department of Health and Human Services, Office of Inspector General (OIG) to make a FWA referral. Their contact phone number is 1-855-MI-FRAUD (643-7283) 8 a.m.-5 p.m. You may leave voicemail message after hours.

You can also use the following to report fraud and abuse to the MDHHS OIG:

You can help support our mission to reduce and eliminate fraud in the health care industry by following a few simple guidelines:

Be careful when providing your health care information, including your member identification number. Be cautious of "free" medical treatments where you are required to provide them with your health care information.

Read your Explanation of Benefits (EOB) carefully. Make sure the services described on the EOB are the same services you received by the doctor.

If you suspect fraud or abuse, let us know. There are two ways you can report it directly to Aetna Better Health Premier Plan of Michigan:

Fill out the form below and submit it online.

You may prefer to contact our Special Investigations Unit by calling 1-866-806-7020 or our Aetna Medicaid-Medicare Compliance Hotline number at 1-855-676-5820.

You do not have to leave your name or any information about yourself to report these types of issues. We will make every effort to protect your identity. We cannot take any action against you for letting us know about any fraud or abuse activities with the health plan.

Protect yourself from scams and identity theft

Health care fraud affects all of us. It impacts the quality of health care. Aetna Better Health of Michigan is dedicated to fight fraud, abuse and waste through its Fraud Prevention Program. This program is designed to detect and eliminate health care fraud, abuse and waste.

What can you do?Know what to look for. It can help you protect your identity and benefits. Be suspicious of:

People trying to sell you health care items or services door-to-door or over the phone

People who offer money or gifts for health care services

Bills for services or equipment you didn't get

Shipments of medical supplies you didn't order

Someone using your ID card to get medical care, supplies or equipment

People offering you free gifts or services in exchange for your ID number

Falsifying timesheets for services not provided or only partially provided

Incorrectly stating a diagnosis to get higher payments

Performing unnecessary services to get higher payments

You can take steps to protect your benefits and your identity

Know who you're sharing information withDon't be afraid to ask questions if someone asks for your personal information. Never give out your Social Security number, health plan numbers, or banking information to anyone you don't know.

There are many different types of fraud, waste and abuse

It’s important to be able to identify these issues and protect your identity and benefits.

Online theft of personal InformationPeople may try to steal your personal or Medicare-Medicaid information online. They can harm you financially and may disrupt your benefits. It's not always easy to distinguish an important email about your benefits from an online scam. An email may say there's a problem with your account or ask for updated information to continue your coverage.

You can help support our mission to reduce and eliminate fraud in the health care industry by following a few simple guidelines:

Be careful when providing your health care information, including your member identification number. Be cautious of "free" medical treatments where you are required to provide them with your health care information.

Telemarketing ScamsMany legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Aetna won't call to ask for your bank account number, Social Security number, ID number or health plan ID number.

What you can do:

Hang up on recorded messages that ask you to verify your personal information.

Don't press any keys or numbers when prompted - even if it's to take your name off their list.

Never give your personal information to someone you don't know.

Online Pharmacy ScamsMost online pharmacies aren't safe or legal. They might send you medicine that is tampered with, expired, or fake. They could use your personal information to steal your identity.

What you can do:

Only order from online pharmacies in your health plan's pharmacy network.

Don't click on links in emails or pop-up advertisements on the internet.

Don't order from pharmacies outside of the United States.

Report pharmacies that:

Offer prescription drugs without a prescription.

Won't accept your prescription insurance card as a form of payment.

Lab Test FraudYour doctor must order genetic tests for Aetna to cover them. Some labs try to offer a free test in order to get your Aetna information. They may try to steal your identity or submit a fraudulent bill.

What to do before you agree to genetic testing:

Make sure your doctor ordered the test.

Make sure the test is medically necessary and that we cover it.

Please use this form to report any suspected fraud, waste or abuse of services of either Aetna Better Health of Michigan's Medicaid or Medicaid-Medicare (Premier Plan) plans. Complete as much information as you can on the form below and click the Submit button when you are finished.